Insurer could drop 8 Wilson clinics from network

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Patients with insurance through UnitedHealthcare could pay out-of-network costs to visit some Wilson Medical Center clinics next year if negotiations remain at a standstill.

“We’re still being assertive with our negotiations and our focus is always on quality patient care and this is part of that,” said Wilson Medical Center CEO Mark Holyoak. “Our hope is that within the next few months, everything will be resolved and there will be no lapse in coverage for anyone.”

Holyoak said a letter recently sent to patients regarding the UnitedHealthcare coverage was a proactive step taken after months of negotiations.

“With UnitedHealthcare, we’re receiving significantly less reimbursement at the physician service level. Their level is significantly less than all other insurance providers, so it has forced us to the point of going back to negotiations,” Holyoak said. “The polite handshake and sit-down hasn’t gotten us anywhere, so we have to be more assertive in negotiations for our patients’ sake.”

Holyoak explained hospital officials, physician services and insurance companies are always in negotiations for coverage, but after reaching an impasse, officials decided to contact patients who could be affected in case no agreement is reached.

“For Wilson Medical Center, all insurances are accepted. For the employed-physician practices, all insurances are currently accepted, but that could change Jan. 1 for UnitedHealthcare patients,” he said. “We wanted to get the word out and give people notice.”

According to the letter, patients with UnitedHealthcare Medicare Advantage or commercial insurance plans could enroll with Blue Cross Blue Shield of North Carolina through Dec. 7 to ensure in-network coverage and fewer out-of-pocket costs. Medicare Advantage customers can learn more by calling 855-582-6979 from 9 a.m. to 7 p.m. on weekdays or visit wilsonmedical.com/medicare for assistance through MedicareCompareUSA. State retirees can switch to Blue Cross at no cost by calling 855-859-0966 before Oct. 31.

“Our hope is for every patient in our community and the surrounding area to have access to the care they need, when and where they need it and from the health care providers of their choice,” Holyoak said.

He said there are only eight providers and fewer doctors who could be affected by failed negotiations.

The possible out-of-network providers are Wilson New Hope Primary Care, Wilson Primary Care, Wilson Internal Medicine Associates, Infectious Disease Consultants, Wilson Gastroenterology, Wilson Neurology, Wilson Regional Orthopedics and Wilson Endocrinology.

“It never feels good to send out a letter like this, especially because our intent is never to cause confusion or anxiety or inconvenience for anyone. Unfortunately, this is probably causing some of that in the community,” Holyoak said. “I want to emphasize, though, that this is not Wilson Medical Center, but a small group of our providers.”

The letter adds that patients are encouraged to contact UnitedHealthcare regarding their concerns about continuity of care.

“As clear as we try to make it, insurance is just confusing all around,” Holyoak said. “Our hope is that we’ll be able to negotiate and everything will be good by January, but we wanted to be proactive and let our patients know what could happen.”